For this litany of errors, many people in authority owe millions of Americans an apology. Richard A. Clarke, former national security adviser, set a good example when he told the commission investigating the 9/11 attacks that he wanted victims’ families “to know why we failed and what I think we need to do to ensure that nothing like that ever happens again.” I’m waiting for similar words from our financial leaders, both public and private. [emphasis mine]

MY work as a freelance writer in Hollywood some time ago prepared me for extreme uncertainty. This is the most insecure existence imaginable. It mandates saving, ingenuity and nonstop work and creativity. Freelancers never have a day off. Never. They know that they can go months without a check. They absolutely have to save. They have to have five different levels of fall-back plans and financial escape hatches.

Although I’ve lived in Berkeley for over 18 years, I still have a special fascination with snow. It doesn’t take much for me to fall into some reverie about snow — for it seems to symbolize a special time and place for me, maybe a time and place that actually never existed.

A few light taps upon the pane made him turn to the window. It had begun to snow again. He watched sleepily the flakes, silver and dark, falling obliquely against the lamplight. The time had come for him to set out on his journey westward. Yes, the newspapers were right: snow was general all over Ireland. It was falling on every part of the dark central plain, on the treeless hills, falling softly upon the Bog of Allen and, farther westward, softly falling into the dark mutinous Shannon waves. It was falling, too, upon every part of the lonely churchyard on the hill where Michael Furey lay buried. It lay thickly drifted on the crooked crosses and headstones, on the spears of the little gate, on the barren thorns. His soul swooned slowly as he heard the snow falling faintly through the universe and faintly falling, like the descent of their last end, upon all the living and the dead.

I just started reading Jerome Groopman’s How Doctors Think. 1st ed. Houghton Mifflin Company, 2007. . (1st ed. Houghton Mifflin Company, 2007.) I remember with some fondness “Eyes Wide Open,” an essay from 2007 in The New Yorker. I picked this book up in hopes of learning how to better deal with doctors, a skill that would come in useful in both mundane and life and death situations.

From what I’ve gleaned so far, Groopman is focused on the type of misdiagnoses made by doctors, which he writes is dominated by cognitive errors:

In one study of misdiagnoses that caused serious harm to patients, some 80 percent could be accounted for by a cascade of cognitive errors, like the one in Anne Dodge’s case, putting her into a narrow frame and ignoring information that contradicted a fixed notion. Another study of one hundred incorrect diagnoses found that inadequate medical knowledge was the reason in only four instances. The doctors didn’t stumble because of their ignorance of clinical facts; rather, they missed diagnoses because they fell into cognitive traps. Such errors produced a distressingly high rate of misdiagnosis. As many as 15 percent of all diagnoses are inaccurate, according to a 1995 report in which doctors assessed written descriptions of patient’s symptoms and examined actors simulating patients with various diseases. These findings match classical research, based on autopsies, which shows that 10 percent to 15 percent of all diagnoses are wrong. (p. 24)

Presumably, I’ll find out from Groopman how I as a patient can help steer my doctors away from cognitive pitfalls that might bring great harm to me and my loved ones. That’s what I get from:

Different doctors, as we will see in later chapters, achieve competency in remarkably similar ways, despite working in disparate fields. Primarily, they recognize and remember their mistakes and misjudgments, and incorporate those memories into their thinking. Studies show that expertise is largely acquired not only by sustained practice but by receiving feedback that helps you understand your technical errors and misguided decisions. (p. 21)

Even more disappointing is Groopman’s attitude towards the most serious effort to rectify this kind of problem, the evidence-based medicine movement. For example, Groopman makes several dismissive remarks about the introduction of Bayesian reasoning in diagnosis and management.